Re: Why does (ovarian) germ cell tumour only occur in teenage/tweenage girls ?

Dear Student,

Ovarian germ cell tumor (OGCT) is an uncommon malignancy, accounting for only 2-3% of all ovarian cancers. Since an estimated 25,400 cases of ovarian cancer were diagnosed in the U.S. in 2003, one would estimate approximately 762 cases of OGCT during the same period¹. Surgery is the initial treatment of choice, followed by chemotherapy in selected cases. OGCT is one of the few "solid tumors" (non-blood cancers) which can be cured by chemotherapy even when widespread (metastatic) disease is present.²

As you noted, OGCT almost always occurs in young women, with the average age of patients in their early 20s.² The evidence suggests that this is, in fact, due to hormonal factors. 15-20% of dysgerminomas (the most common subclass of OGCT) occur during or shortly after pregnancy.³ One study showed that hormonal factors affecting the patient's mother, such as use of hormonal medications, age at first pregnancy of less than 20, or obesity (which is increased with increased levels of female hormones), are associated with increased risk of OGCT in patients themselves.⁴ OGCT seems to be analogous in some ways to testicular cancer in men, which also occurs most commonly in young adulthood.

Thanks for your question!

Stephen C. Lattanzi, M.D.

References

1. Jemal A. Cancer statistics, 2003. CA Cancer J Clin 2003; 53: 5- 26.

2. Ozols RF et al. Ovarian cancer, fallopian tube cancer, and peritoneal cancer. In: De Vita VT Jr. et al. Cancer: principles and practice of oncology, ed. 6. Lippincott, Williams & Wilkins, 2001. pp. 1597-1632.

3. Williams SD. Ovarian germ cell tumors: an update. Semin Oncol 1998; 25: 407-13.

4. Walker AH. Hormonal factors and risk of ovarian germ cell cancer in young women. Br J Cancer 1998 Apr; 57(4): 418-22.